Growing up inside
Serious challenges remain over the health and care of children in young offender institutions, as well as for younger people in prisons across the country. That is the conclusion of new Nuffield Trust analysis which shows missed appointments and admissions relating to violent incidents or self-harm are far more common among younger people in prisons, while support within the system for people with neurodivergent conditions remains a concern, with diagnoses of ADHD associated with higher hospital admissions for violence among young adult males. As usual, the Miranda Davies led the research.
This analysis uses routinely collected hospital data to look at the service-use patterns of children and young adults aged 25 and under in young offender institutions and prisons in England. Looking across the children’s secure estate as well as the adult estate provides a novel perspective on the key health care issues for young people, allowing comparison between the two estates.
This is particularly important, because the distinction between the two parts of the system is becoming increasingly blurred. Recently, population pressures in the adult estate have led to an increase in the number of young people aged 18 or over in the children’s secure estate, which will drastically alter the age profile of the children’s secure estate population.
42% of hospital admissions by young adult males in custody had a primary diagnosis of injury or poisoning. This was significantly higher than among the adult prisoner population, where injury or poisoning accounted for just 16% of hospital admissions.
Some 60% (n=55) of hospital admissions for young adult males in prison where a diagnosis of attention deficit hyperactivity disorder (ADHD) was flagged had a primary diagnosis of injury or poisoning. This was significantly higher than for young adult males without ADHD, where it accounted for 41% of admissions.
Boys detained in young offender institutions had a higher proportion of outpatient appointments cancelled on their behalf (18%) than both young adult males (14%) and other adult males (13%) in prison.
The children and young people secure estate has much higher staff–child ratios than is the case with prisoners in the adult estate, which affects the culture in each and makes the transition between the two more complex. This means that day-to-day activities in these institutions are less likely to be cancelled due to a lack of staff and staff are more familiar with those under their care and can potentially develop better relationships with them. At the most basic level, staff need to be in place to provide the tailored support for young adults that is so clearly needed.
The report sets out three main recommendations aimed at different government bodies. For ease of understanding the Children’s Secure Estate signatories include Department for Education, Department of Health and Social Care, UK Health Security Agency, Ministry of Justice and NHS England. The Health & Social Care signatories include Department of Health and Social Care, His Majesty’s Prison and Probation Service, the Ministry of Justice, NHS England, and the United Kingdom Health Security Agency.
For Children and Young People Secure Estate National Partnership signatory organisations
Understand and address the reasons why outpatient appointments for children and young people in young offender institutions are cancelled much more often than is the case for people in prisons. Make data on reasons why hospital appointments are missed publicly available. This is important so that action can be taken, and national partnership members can be held accountable.
For National Partnership Agreement for Health and Social Care for England signatory organisations
Develop specific national guidance or standards relating to health care for young adults in secure settings. We support the need to address the key health care issues for young people as part of any future national strategy for young adults in the secure estate.
For HM Prison and Probation Service
Ensure all staff have sufficient understanding of, and training in, neurodiversity. This should be considered as part of staff recruitment, initial training, ongoing training and awareness-raising activities within secure settings.
Thanks to Andy Aitchison for kind permission to use the header image in this post. You can see Andy’s work here